2023 Archdiocese of Atlanta Meritain Group Plan Doc - Manual / Resource - Page 53
(g)
Removal of impacted teeth.
General anesthesia and Hospital expenses for a person who is: (a) 7 years of age or younger or is
developmentally disabled; (b) an individual for which a successful result cannot be expected from dental care
provided under local anesthesia because of a neurological or other medically compromising condition of the
Covered Person; or (c) an individual who has sustained extensive facial or dental trauma.
(16) Diabetic Education: The following diabetic education and self-management programs: diabetes outpatient
self-management training and education, including medical nutrition therapy that is provided by a certified,
registered or licensed healthcare professional working in a program consistent with the national standards of
diabetes self-management education as established by the American Diabetes Association. Coverage is
provided for individuals with insulin-dependent diabetes, insulin-using diabetes, gestational diabetes and
noninsulin-using diabetes who adhere to the prognosis and treatment regimen prescribed by a Physician.
(17) Diabetic Supplies: All Physician-prescribed medically appropriate and necessary equipment and supplies
used in the management and treatment of diabetes that are not covered under the Prescription Drug Card
Program, including therapeutic shoes and inserts.
(18) Diagnostic Testing, X-ray and Laboratory Services: Diagnostic testing, x-ray and laboratory services,
including services of a professional radiologist or pathologist. Dental x-rays are not eligible expenses, except
as specified under Dental Care.
The use of Quest Diagnostics is strictly voluntary. If a Covered Person uses the services of Quest Diagnostics,
benefits will be payable as shown in the Medical Schedule of Benefits. When a Physician orders laboratory
work, the Covered Person should present the Employee insurance card and verbally request to use Quest
Diagnostics. The Physician will then collect the specimen and send to Quest Diagnostics. Any Physician can
collect specimens and call (800) 343-3140 for courier pick-up and supplies. In the event the Physician does
not participate with Quest Diagnostics, simply take the test orders to an approved collection site for the draw.
Collection site locations can be found by calling or by going to the website at:
www.aetna.com/docfind/custom/mymeritain
The use of Quest Diagnostics covers routine outpatient testing. It does NOT cover: (a) testing ordered during
hospitalization; (b) lab work needed on an emergency or STAT basis; (c) testing done at another laboratory;
or (d) time sensitive esoteric testing such as bone marrow studies and spinal fluid tests.
Eligible expenses will be payable as shown in the Medical Schedule of Benefits.
(19) Durable Medical Equipment: The rental of wheelchairs, walkers, special Hospital beds, iron lungs and other
Durable Medical Equipment subject to the following:
(a)
The equipment must be prescribed by a Physician and Medically Necessary; and
(b)
The equipment will be provided on a rental basis; however, such equipment may be purchased at the
Medical Plan's option. Any amount paid to rent the equipment will be applied towards the purchase
price. In no case will the rental cost of Durable Medical Equipment exceed the purchase price of the
equipment; and
Benefits will be limited to standard models as determined by the Medical Plan; and
(c)
(d)
The Medical Plan will pay benefits for only one of the following unless Medically Necessary due to
growth of the Covered Person or if changes to the Covered Person's medical condition requires a
different product, as determined by the Medical Plan: a manual wheelchair, motorized wheelchair or
motorized scooter; and
(e)
If the equipment is purchased, benefits will be payable for subsequent repairs, excluding batteries,
necessary to restore the equipment to a serviceable condition. If such equipment cannot be restored
to a serviceable condition, replacement will be considered eligible subject to prior approval by the
Medical Plan. In all cases, repairs or replacement due to abuse or misuse, as determined by the
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